Caring for traumatic brain injury in children can be a challenge!

Traumatic brain injury is the most common cause of morbidity and mortality in children. However, it is still challengeable to early predict the outcome of individual patients with severe head injuries. Glasgow outcome scale is the most widely used scoring system in evaluating neurological outcome for head injury patients. Moreover, it is likely to underestimate morbidity and is not always readily applicable in children. It is an important issue to develop a practical, reliable and valid neurological outcome instrument in children in forwarding research.

Single photon emission computed tomography scanning: A predictor of outcome in vegetative state of head injury

BACKGROUND

Neurotrauma is one of the most important causes of death and disability. Some of the severely head injured patients, failed to show significant improvement despite aggressive neurosurgical management and ended up in a vegetative state.

AIMS

To assess the outcome at six months and one year using Glasgow outcome scale (GOS), in this prospective study on patients with severe head injury, who remained vegetative at one month.

MATERIALS AND METHODS

This prospective study was carried out in the department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, over a period of a year and a half (March 2002 through July 2003).

MATERIALS AND METHODS

In patients with severe head injury (GCS < 8), post resuscitation, neurological assessment was done with Glasgow coma scale (GCS), pupillary light reflex, doll's eye movement and cold caloric test in all cases. Fifty patients, who remained vegetative post injury according to the criteria of Jennett and Plum, at one month, were considered for the study. Brain SPECT (Single Photon Emission Computed T omography) Scanning was carried out in selected cases.

STATISTICAL ANALYSIS

Data analysis was done by Pearson's chi-square test on computer software SPSS, Version 10 (California, USA).

RESULTS

Patients with preserved brainstem reflex and with no perfusion defect on SPECT scan had statistically significant favorable outcome. More than 40% of vegetative patients regained consciousness by the end of one year, of whom 24% had favorable outcome in the form of moderate disability and good recovery.

CONCLUSION

SPECT is better than computed tomography/magnetic resonance imaging (CT/MRI) as it assesses the cerebral perfusion and functional injury rather than detecting the lesions only. Further study with a control group is necessary to establish the role of SPECT in head injury.

Emergency neurological care of strokes and bleeds

Ischemic stroke and brain hemorrhage are common and challenging problems faced by emergency physicians. In this article, important details in the diagnosis and clinical management of these neurological emergencies are presented with the following goals: 1) To provide a more comprehensive understanding of the approach to the identification and management of patients who have sustained ischemic and hemorrhagic strokes; 2) to explain the importance and application of commonly used national stroke scoring and outcome scales; 3) to improve the ability to recognize important aspects in the approach and comprehensive treatment of ruptured and unruptured intracranial aneurysms; and 4) to demonstrate the difficulties in the neurological, neurosurgical, and endovascular treatment of these catastrophic diseases.

The effect of barbiturate coma therapy for the patients with severe intracranial hypertension: a 10-year experience

OBJECTIVE

Barbiturate coma therapy (BCT) has been known to be an useful method to control increased intracranial pressure (IICP) refractory to medical and surgical treatments. We have used BCT for patients with severe IICP during the past 10 years, and analyzed our results with review of literatures.

METHODS

We analyzed 92 semicomatose or comatose patients with Glasgow coma scale (GCS) of 7 or less with severe IICP due to cerebral edema secondary to parenchymal damages irrespective of their causes. Forty patients who had received BCT with ICP monitoring from January 1997 to December 2006 were included in BCT group, and fifty-two patients who had been managed without BCT from January 1991 to December 1995 were divided into control group. We compared outcomes with Glasgow outcome scale (GOS) and survival rate between the two groups.

RESULTS

Good outcome (GOS=4 and 5) rates at 3-month after insult were 27.5% and 5.8% in BCT and control group, respectively (p<0.01). One-year survival rates were 35.9% and 12.5% in BCT and control group, respectively (p<0.01). In BCT group, the mean age of good outcome patients (37.1 +/- 14.9) was significantly lower than that of poor outcome patients (48.1 +/- 13.5) (p<0.05).

CONCLUSION

With our 10-year experience, we suggest that BCT is an effective treatment method for severe IICP patients for better survival and GOS, especially for younger patients.